The priority for dental therapists should be fighting for better resourcing to improve Kiwi kid’s poor dental health – not to provide adult care, says the New Zealand Dental Association.

Dr David Crum, the  chief executive of the NZDA, was responding to a call by Dental & Oral Health Therapists’ Association chair Arish Naresh to consider greater use of dental therapists for adolescent and adult basic dental care.

Currently the vast majority of the just under 1000 dental and oral therapists work for district health boards providing free school dental health services up to the age of 13, though they can work with adolescents up to the age of 18. Across the Tasman dental therapists with a postgraduate qualification can provide basic dental care for all ages.

Crum said rather than “diluting” the limited dental therapist workforce further by moving into adult care a more sensible argument would be better resourcing to achieve the dental health results that New Zealand children deserve.

“I say that because – while they (therapists) claim they have really high enrolment rates at one or two years of age  – when kids are getting to school we’ve got around 50 per cent of kids with holes in their teeth that haven’t been seen or treated,” said Crum.  He said nationally one in six kids are not being seen or are overdue for check-ups.

“We know the national rate of hospital admissions for children requiring general anaesthetic has quadrupled since 1990,” he said.  “About 7500 kids in the 0-14 age group had to have general anaesthetic to have teeth extracted last year.”

“So what I’m saying it is great to have the thought that you might like to dilute the service further by suggesting an expansion of the role of dental therapists to all age groups… But the reality is that we need to be looking after our kids first and foremost.”

Fluoridation and reducing sugar consumption a major focus for NZDA

Naresh, who is also Director of Allied Health and Technical of Tairawhiti District Health Board and manages the DHB’s dental services, was initially responding to Helen Clark’s comments that dental care should be a basic right.

Crum said the evidence was that there had been a dramatic improvement in adult tooth decay rates in the past 20 years but there was still a sector of the community that could not afford routine dental check-ups or treatments so he believed that targeted and consistent dental subsidies needed to be available for those with genuine need.

He said the Dental Association was also strong advocates for preventing dental disease through community water fluoridation – which was proven to reduce the dental decay rate by 40 per cent – and public health policies to reduce sugar consumption.

“It’s either getting serious about preventing the disease or by being willing to spend a huge amount of money treating it,” said Crum. That also included ensuring good dental care for children and adolescents to reduce adult dental disease levels.

“It’s a slow path but that’s a path for change,” said Crum. “Providing free treatment for ever more without preventing the cause of the disease is a roundabout and you just stay on it.”

The therapists’ association chair Naresh believed a team made up of not only dentists but also other dental health professionals – like dental and oral health therapists (see definitions and scopes of practice at end of article) – working at the top of their scope could help make adult dental care more accessible and affordable and at the same time improve the country’s oral health.

Improving take-up of free care from age 13-18

Naresh also supported a preventative approach to dental care and believed a better service delivery model was needed for 13-18 year olds so more adolescents were utilising the free service – mostly provided by dentists – already in place.  Currently the enrolment for free care drops from around 95 per cent up to the age of 12 down to as low as 54 per cent in some areas once they turn 13.

The new Minister of Health, Dr David Clark, told the Association of Salaried Medical Specialists’ conference last week that he agreed in principle with affordable oral healthcare but the government needed to also be fiscally responsible.  He indicated workforce changes would be needed to increase the affordability of dental care and the first priority should be ensuring under-18s received the free care they were eligible for.

Crum said a very easy way of increasing the take-up of free dental care by adolescents was to return to a system whereby the school dental therapists took back the responsibility for ensuring that before young people were discharged from the school dental service that they were enrolled with their local dentist.

“Now enrolment forms get given out at schools to the child, who puts them in their school bag, who might give them to their parents, who might fill it out and might take it to a dentist who will eventually contact them,” he said. “There are a number of steps in there that mean you greatly decrease the number of enrolments.”

At March 31 this year there were 999 dental therapists registered with the Dental Council (including oral health therapists) which is up from 673 in 2007 – a 48 per cent growth rate over a decade. Over the same time period the dentist and dental specialist workforce has grown from 1179 to 2879  – a 61.8 per cent growth rate.

In 2015 68 per cent of therapists were employed in District Health Boards and around 14 per cent were in private practice either as employees or self-employed.

Dental health professional roles:

  • Dentist:The Dental Council defines the practise of dentistry as “the maintenance of health through the assessment, diagnosis, management, treatment and prevention of any disease, disorder or condition of the orofacial complex and associated structures within the scope of the practitioner’s approved education, training and competence”.
  • Oral Health Therapist:Oral health degree graduates from 2008 have a new dual scope which basically contains both the dental therapist and dental hygienist scopes. Including diagnosing and treat dental cavities for patients up to the age of 18 and carrying out dental hygienist treatments on adults (including scaling).
  • Dental Therapist:Scope of practice that evolved from the original school dental nurse role which includes oral health promotion, diagnosing and treating dental cavities for patients up to the age of 18 and extracting baby teeth.
  • Dental Hygienist:Scope of practice is largely focused on the prevention and non-surgical treatment (e.g. removing tartar) of periodontal disease.
  • Dental Assistant: Assistant trained to support dentist in their practice

 

2 COMMENTS

  1. Mr. Crum expresses a very narrow point-of view in the article above. The NZ Ministry of Health figures show some improvement in children’s oral health in recent years; however, inequalities in oral health are still a serious issue, with Māori, Pacific Island and children of lower socioeconomic status having poorer oral health. It is likely that many 5-year-olds starting school or preschoolers requiring GAs are from these groups. While there are issues with the recruitment and retention of dental and oral health therapists, including DHB funding being available to employ dental and oral health therapists, the wider social determinants of health play the major role in children’s oral health. There are more children living in poverty than ever before – while dental care is free, their parents may not be able to afford the cost of transport to appointments, or may have other major life priorities to deal with, such as other serious health issues, finding money for rent and food etc. In addition to this, the average child’s diet has changed much in previous years; as well as having access to many more sugar-sweetened beverages than before, often the healthiest food choice is the most expensive choice. Those on lower incomes tend to choose foods that are cheaper, but higher in sugar, fat and salt. (For more information about inequalities in oral health for New Zealand children, refer to: https://www.frontiersin.org/articles/10.3389/fpubh.2017.00177/full.)

    In the 1970s, there was much talk from the NZDA about ‘team-work’ but this has never really eventuated in New Zealand due to, I believe, concerns about different occupational groups encroaching on one-another’s ‘territory’. Rather than expecting dental and oral health therapists to ‘… [fight] for better resourcing to improve Kiwi kid’s poor dental health’, perhaps it is time to work more closely together, to improve children’s oral health and, particularly, inequalities in oral health.

  2. David Crum continues the 8 year old 2009 Oral Health Survey data on fluoridation. The recent MOH school dental stats show no difference in tooth decay for fluoridated v non-fluoridated.

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